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Feature article summaries and commentary on a variety of VIR topics such as uterine fibroid and prostate embolization, angioplasty, chemoembolization, and endovascular treatment of peripheral arterial disease.

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Tuesday, May 12, 2015

The presence of viable or recurrent tumor after transarterial chemoembolization of HCC is thought to be in part attributable to chemotherapy resistance and ischemia-induced angiogenesis via a principle mechanism of tumor gene expression. This study was performed to evaluate the relationship between expression of tumor biomarker genes in HCC cells and subsequent treatment response to transarterial chemoembolization.

In this retrospective feasibility pilot study, 19 pretreatment HCC biopsy specimens from 19 patients treated with conventional chemoembolization between 2007 and 2013 were analyzed for the presence and expression of 60 genes related to chemotherapy sensitivity, mitosis, inflammation, hypoxia, and angiogenesis. Quantification of gene expression based on measurement of mRNA levels was compared to post-treatment tumor response by imaging at a mean of 116 days after treatment.

Tumors with a complete response (N=13) showed a significant increase in or trend toward greater (range, 1.49-3.50 fold) pre-treatment mRNA expression of a number of chemotherapy-sensitivity and mitosis genes compared with tumors with a partial response (N=6). Tumors with a complete response also showed significantly higher VEGFA levels compared to those with partial response, which may indicate an association between greater pre-treatment tumor vascularity and susceptibility to transarterial locoregional therapies.

Comment:

Establishment of the relationship between inherent pre-treatment HCC gene expression and treatment response to transarterial chemoembolization may allow better pre-treatment predictability of individual tumor response and better inform locoregional HCC management decisions at the level of the individual, or amongst multiple tumors within an individual. Further studies to identify additional markers, better understand and quantify their relationships with tumor response, and establish the reliability of predictions based upon these relationships will be an important step forward in the further individualization of HCC management.